The result? Approximately 10.3 percent of uncircumcised men in the uncircumcised group became infected with genital herpes, compared to 7.8 percent in the circumcised group. And, at 24 months, 18 percent of circumcised men were found to have HPV compared to 27.9 percent of the control group. Circumcision had no effect on the rate of syphilis.
The study in question consisted of the combined results of two randomized controlled trials of circumcision to reduce the transmission of sexually transmitted diseases in heterosexual men. In these studies, individuals were either assigned to immediate circumcision or circumcision at 24 months after enrollment. Despite randomization, there were some baseline differences between the study groups. Men in the early circumcision group were more likely to use condoms in the first 6 months after the surgery and were also more likely to have non-marital sexual relationships (although not a higher number of sexual partners.) In contrast the men in the control, late-circumcision, group were more likely to use alcohol as a companion to sex - which tends to increase risky behaviors. However, the reduction in HPV and herpes risk remained even after adjusting for these factors.
Along with earlier research that showed a link between circumcision and reduction in HIV risk, this study supports the possible use of circumcision as an intervention to reduce sexually transmitted diseases in high-risk heterosexual populations. The benefits of adult circumcision, however, may be less profound in areas such as the U.S. where the prevalence of childhood circumcision is already high. Nonetheless, it will be interesting to see how this research affects both insurance coverage for adult circumcision and the American Academy of Pediatrics' stated policy on childhood circumcision.
Sources:
Tobian A.A.R. et al. (2009) "Male Circumcision for the Prevention of HSV-2 and HPV Infections and Syphilis" N Engl J Med 360:1298-309.
